Anti-depressants: An Appraisal from experience
I first got prescribed anti-depressants in 2010 by my GP when I dropped out of Oxford. I’ve realised, despite only being at Oxford for less than a term, that it is actually a big part of who I am and has been a key part in forming my current outlook and attitude to life. It was relatively tough at 19 to go through all that- to feel behind all my school friends and like I was lacking direction and in a position of such uncertainty. However, because I took two years out I fully jumped off the conveyor belt of expectation and even though it was hard at the time, it has made me much more self-aware and passionate about doing what makes me happy. I think it has also made me more acutely aware of what doesn’t make me happy, and this sensitivity to circumstance is probably why I have struggled with my mental health through my 20s.
Anyway back in 2009 I never took the anti-depressants that my GP prescribed. I remember staring at these yellow and green pills and feeling almost worse about the prospect of taking something that confirmed I was unwell than I actually felt about myself generally. So I ignored them. And then I was mostly fine for a few years. As I said in my blog post about misunderstanding in mental health my mental health didn’t deteriorate profoundly until I was on my placement year during my third year of university. At this point, I was referred for a course of counselling for clinical depression and generalised anxiety disorder. After my first session with the counsellor, he suggested I take anti-depressants.
The counsellor suggested I trial Fluoxetine (brand name Prozac) which is in the Selective Serotonin Reuptake Inhibitor class of anti-depressant. Despite studying Biology I didn’t know much about the pharmacological action of anti-depressants, and I was also still terrified of the thought of taking them. I was also scared about the stigma around the medication- that they are apparently bad because you should be strong and deal with it yourself, or that you can get dependent on them. Coupled with these concerns, I was also someone who hated taking any medication for anything that didn’t seem like an exact science to me- even paracetamol for a headache. However, my counsellor (who was near retirement) said he had seen a lot of people in my position, and seen people progress and come out the other side. His anecdotes and his empathy gave me reassurance, and importantly, the confidence to at least try it.
With trepidation, I started taking the anti-depressants. 20mg of Fluoxetine a day. This is the standard starting dose of Fluoxetine although it does vary depending on severity of symptoms. By this time I had done a bit more research on how the drugs work- basically a Selective Serotonin Reuptake Inhibitor (SSRI) does what it says on the tin: it inhibits the reuptake of serotonin in the brain. It is selective because it acts specifically on Serotonin levels, as opposed to any other neurotransmitters. There are other classes of anti-depressants but SSRIs are the most commonly prescribed for depression and/or general anxiety (as well as a host of other MH conditions including OCD and binge-eating disorders).
I didn’t really know what to expect but the side-effects hit me pretty rapidly, within a couple of days. Firstly, the dreams were insane. Like any lucid dream you have had- multiply it by 100. It was so unnerving. I woke up in the night in huge panics and it was very unsettling. On top of that- the tiredness- I felt so exhausted all of a sudden. I had to somehow get home at lunch from my job and get as much sleep as possible. There were some other occasional side effects such as an electric zap feeling in my brain, and also grinding my teeth in my sleep.
The other difficult aspect of commencing the medication was that I actually felt worse initially. This is a common phenomenon in starting a course of anti-depressants, and the reason for this is still relatively unclear. Feeling worse before better was definitely the case for me. I felt like a zombie, and I felt so depressed. I constantly battled with this feeling, wondering whether I should stop taking the meds because the turbulence of adapting to them was just too much on top of my existing problems. Luckily, I saw my counsellor every week at this acute stage, and the feeling of having that weekly checkpoint helped me both in literal terms in the session but also in more indirect ways outside of it; sometimes just knowing you have an anchor or someone who cares can be hugely helpful when you are struggling.
I stuck with them and at about 6 weeks in, almost as if a switch had flicked in my brain, I felt different. The initial side effects had almost entirely disappeared and I had this new found enthusiasm for everything- for work, for friends, for exercise- for life basically. It was like I had been living in a constant state of greyness (the song Grey Room by Damien Rice is perfect for describing this mood) and all of a sudden I saw colour in everything- and I felt hopeful. I wanted to go running and appreciate nature. I wanted to get on a train to see a friend I had been ignoring for 6 months because I’d been so damn depressed. I wanted to make up on all this lost time. With all the angst and inhibitions removed I was able to inject a newfound energy into my placement year. I built my network and ended the year on such a positive note having made a discernible difference to the team.
I couldn’t believe that this little green and yellow pill, the one I had stared at three years before when I was originally prescribed them, the one I had been terrified of taking, and the one I thought represented that I was weak, had essentially changed my life. I also think it’s important to note here that I don’t believe it’s the pill making you into someone you are not; in my opinion it gives you the impetus to be who you really are. I have a couple of analogies for what I believe it’s like for me. I will try and articulate one of them:
Imagine doing life is an obstacle course, and every day there is a huge wall in front of you that you have to get over to do the actual living life thing on the other side. When I’m depressed, I think about the wall as soon as I wake up. It paralyses me. I sometimes resolve to just be positive and get over the wall but as soon as I approach it, it looks like too much effort, and I’m also scared about what’s on the other side. At the same time I don’t want to give the wall so much power- I know what is on the other side isn’t that scary and I will be fine once I’m there. There are even people reassuring me that it’s fine and offering to help me over the wall. However, in spite of myself and in the short-term, it’s easier to just not climb the wall. This continues to happen, day after day, week after week, until you realise that nobody is trying to help you get over the wall anymore, and it feels like you can never get over it ever again by yourself. So basically you can’t live life- I mean sure you’re living as in you’re doing things, but you’re not really experiencing them-you’re just doing what you need to do to simply get by. For me, what the medication does, is it changes my attitude to the wall- I just see it as a thing that has to be done. I get up, I climb over, I do life and I enjoy it. Simple. Why does that require any overanalysis? And once I’m on the other side, I’m fine after all. Then the feedback loop sets in- getting over the wall is fine, the other side is great, keep going. Sure there are dips, just like there are in all of life, but they aren’t a huge setback or cause for concern like they are when I’m depressed. This liberation from your own brain is one of the best feelings that I’ve experienced in my life. It makes me feel so free. And the release of that self-inflicted weight is so motivating. (Read Milan Kundera’s The unbearable lightness of being if you are interested in the concept of life being ‘light’ and ‘heavy’).
My biggest mistake was getting to a point after 6 months where I believed I didn’t need the medication anymore. I was fine. Life was fine. The pill was redundant to me. My GP wanted me to stay on for at least a year (this is the timeline where studies show chance of relapse is dramatically reduced) but I was convinced I needed to come off. To cut a long story short, eventually I plummeted back down again. I couldn’t get over the wall, and then another 6 months later I’m back picking up my prescription for my old friend again. I actually call ‘him’ Professor Zac as an alias of ProZac- something that my friends think is funny and it allows me to break down the barrier when I first bring it up if I need to talk. Since the first time, going on and coming off has happened two more times (over the past 3 years). I didn’t learn from my mistakes and got caught by the 6 month curse every time. I eventually learnt my lesson and I have now been on Prozac for 18 months.
I’ve realised now that there is no shame in me staying on them for a long time. When I feel better (which I basically do now), it should not be reason to dismiss the meds as something redundant. If I practice what I preach about mental vs physical illness then I shouldn’t see any issue in being on them in the long term. I have a thyroid condition and have to take thyroid hormone replacement every day. I feel fine physically, but I’m not going to stop taking it because my thyroid symptoms when I’m untreated are near impossible to function with. Why should it be any different for the anti-depressants? Maybe I should be fine without them, or learn to be normal without the external chemical support, but I’ve accepted now, after so much lability over the past three years that I am, ultimately, much better when I am taking them compared to when I am not. I am more positive, more pro-active and happier. I see Professor Zac in a very fond light because he has helped me to reach my potential, and even though I’ve treated him with resistance and resentment at times, he has picked me back up three times now, and to be candid he has also saved my life.
I must add a caveat to the above. It sort of reads as if I’m advocating anti-depressants as a one size fits all solution. They aren’t. Their effects really vary between people, because we ourselves vary. We have different feelings, experiences, circumstances, chemicals and brains. An individual’s response to the medication may vary even between different SSRIs (Prozac vs. citalopram, for example), and some people may experience long-term side effects which to them are worse than the depression or anxiety (e.g. emotional numbing and loss of libido). I do definitely feel more ‘numb’ on the medication but I don’t actually see that as a terrible thing. I am, without them, extremely emotionally labile, so taking the edges off of that hugely helps me. Also the numbness gives me a break from the introspection and overanalysis which makes me feel so much freer in myself. My only real advice is to not avoid trying them for the wrong reasons- i.e. the stigma surrounding it or the ‘myths’ about what they do or how they make you feel. Since starting on medication, and being relatively open about it with people, I have realised just how many people are also on them; it’s actually pretty ubiquitous. Anti-depressants have turned my life around on more than one occasion and I do feel very passionate about the positive aspects of them because of this. I have also witnessed friends get out of deep and dark holes after commencing anti-depressants. In my opinion they are not your saving grace but they let you save yourself.